scholarly journals Opportunities to Improve Shared Decision Making in Dialysis Decisions for Older Adults with Life-Limiting Kidney Disease: A Pilot Study

2020 ◽  
Vol 23 (5) ◽  
pp. 627-634 ◽  
Author(s):  
Christopher J. Zimmermann ◽  
Roy A. Jhagroo ◽  
Maureen Wakeen ◽  
Kathryn Schueller ◽  
Amy Zelenski ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Pilot Study ◽  
Kidney Disease ◽  
Shared Decision Making ◽  
Shared Decision

scholarly journals Nephrologists’ emotional burden regarding decision-making about dialysis initiation in older adults: a qualitative study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Melissa W. Wachterman ◽  
Tarikwa Leveille ◽  
Nancy L. Keating ◽  
Steven R. Simon ◽  
Sushrut S. Waikar ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Kidney Disease ◽  
Shared Decision Making ◽  
Conservative Management ◽  
The United States ◽  
Structured Interview ◽  
Dialysis Initiation ◽  
Shared Decision ◽  
Emotional Burden

Abstract Background Conservative management, an approach to treating end-stage kidney disease without dialysis, while generally associated with shorter life expectancy than treatment with dialysis, is associated with fewer hospitalizations, better functional status and, potentially, better quality of life. Conservative management is a well-established treatment approach in a number of Western countries, including the United Kingdom (U.K.). In contrast, despite clinical practice guidelines in the United States (U.S.) recommending that nephrologists discuss all treatment options, including conservative management, with stage 4 and 5 chronic kidney disease patients, studies suggest that this rarely occurs. Therefore, we explored U.S. nephrologists’ approaches to decision-making about dialysis and perspectives on conservative management among older adults. Methods We conducted a qualitative research study. We interviewed 20 nephrologists – 15 from academic centers and 5 from community practices – utilizing a semi-structured interview guide containing open-ended questions. Interview transcripts were analyzed using grounded thematic analysis in which codes were generated inductively and iteratively modified, and themes were identified. Transcripts were coded independently by two investigators, and interviews were conducted until thematic saturation. Results Twenty nephrologists (85% white, 75% male, mean age 50) participated in interviews. We found that decision-making about dialysis initiation in older adults can create emotional burden for nephrologists. We identified four themes that reflected factors that contribute to this emotional burden including nephrologists’ perspectives that: 1) uncertainty exists about how a patient will do on dialysis, 2) the alternative to dialysis is death, 3) confronting death is difficult, and 4) patients do not regret initiating dialysis. Three themes revealed different decision-making strategies that nephrologists use to reduce this emotional burden: 1) convincing patients to “just do it” (i.e. dialysis), 2) shifting the decision-making responsibility to patients, and 3) utilizing time-limited trials of dialysis. Conclusions A decision not to start dialysis and instead pursue conservative management can be emotionally burdensome for nephrologists for a number of reasons including clinical uncertainty about prognosis on dialysis and discomfort with death. Nephrologists’ attempts to reduce this burden may be reflected in different decision-making styles – paternalistic, informed, and shared decision-making. Shared decision-making may relieve some of the emotional burden while preserving patient-centered care.

High-risk surgery among older adults: Not-quite shared decision-making

Surgery ◽  
2021 ◽  
Author(s):  
Ana C. De Roo ◽  
Crystal Ann Vitous ◽  
Samantha J. Rivard ◽  
Michaela C. Bamdad ◽  
Sara M. Jafri ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
High Risk ◽  
Shared Decision Making ◽  
Shared Decision

scholarly journals EFFECTS OF A SHARED DECISION MAKING INTERVENTION FOR OLDER ADULTS WITH CHRONIC CONDITIONS: AN OBSERVATIONAL STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S296-S297
Author(s):  
Ruth E Pel-Littel ◽  
Bianca Buurman ◽  
Marjolein van de Pol ◽  
Linda Tulner ◽  
Mirella Minkman ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Observational Study ◽  
Shared Decision Making ◽  
Chronic Conditions ◽  
Decisional Conflict ◽  
Future Research ◽  
Multiple Chronic Conditions ◽  
Shared Decision ◽  
Perceived Involvement

Abstract Shared decision making (SDM) in older patients is more complex when multiple chronic conditions (MCC) have to be taken into account. The aim of this research is to explore the effect of the evidence based implementation intervention SDMMCC on (1) the preferred and perceived participation (2) decisional conflict and (3) actual SDM during consultations. 216 outpatients participated in a video observational study. The intervention existed of a SDM training for geriatricians and a preparatory tool for patients. Consultations were videotaped and coded with the OPTIONMCC. Pre- and post-consultation questionnaires were completed. Participation was measured by the Patients’ perceived Involvement in Care Scale (PICS). Decisional conflict was measured by the Decisional Conflict Scale (DCS). The patients mean age was 77 years, 56% was female. The preparatory tool was completed by 56 older adults (52%), of which 64% rated the tool as positive. The preparatory tool was used in 12% of the consultations. The mean overall OPTIONMCC score showed no significant changes on the level of SDM(39.3 vs 39.3 P0.98), however there were significant improvements on discussing goals and options on sub-items of the scale. There were no significant differences found in the match on preferred and perceived participation (86.5% vs 85.0% P 0.595) or in decisional conflict (22.7 vs 22.9 P0.630). The limited use of the preparatory tool could have biased the effect of the intervention. In future research more attention must be paid towards the implementation of preparatory tools, not only among patients but also among geriatricians.

scholarly journals The Need for Accurate Risk Prediction Models for Road Mapping, Shared Decision Making and Care Planning for the Elderly with Advanced Chronic Kidney Disease

PRILOZI ◽  
2016 ◽  
Vol 37 (2-3) ◽  
pp. 33-42 ◽  
Author(s):  
Marijke Stryckers ◽  
Evi V Nagler ◽  
Wim Van Biesen
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Shared Decision Making ◽  
Risk Prediction ◽  
Prediction Models ◽  
Shared Decision ◽  
End Stage Kidney Disease ◽  
Risk Prediction Models ◽  
End Stage

AbstractAs people age, chronic kidney disease becomes more common, but it rarely leads to end-stage kidney disease. When it does, the choice between dialysis and conservative care can be daunting, as much depends on life expectancy and personal expectations of medical care. Shared decision making implies adequately informing patients about their options, and facilitating deliberation of the available information, such that decisions are tailored to the individual’s values and preferences. Accurate estimations of one’s risk of progression to end-stage kidney disease and death with or without dialysis are essential for shared decision making to be effective. Formal risk prediction models can help, provided they are externally validated, well-calibrated and discriminative; include unambiguous and measureable variables; and come with readily applicable equations or scores. Reliable, externally validated risk prediction models for progression of chronic kidney disease to end-stage kidney disease or mortality in frail elderly with or without chronic kidney disease are scant. Within this paper, we discuss a number of promising models, highlighting both the strengths and limitations physicians should understand for using them judiciously, and emphasize the need for external validation over new development for further advancing the field.

Shared Decision Making to Improve the Emergency Care of Older Adults: A Research Agenda

2016 ◽  
Vol 23 (12) ◽  
pp. 1386-1393 ◽  
Author(s):  
Teresita M. Hogan ◽  
Natalie L. Richmond ◽  
Christopher R. Carpenter ◽  
Kevin Biese ◽  
Ula Hwang ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Shared Decision Making ◽  
Emergency Care ◽  
Research Agenda ◽  
Shared Decision

scholarly journals Factors promoting shared decision-making in renal replacement therapy for patients with end-stage kidney disease: systematic review and qualitative meta-synthesis

2021 ◽  
Author(s):  
Yu Shi ◽  
Wang Li ◽  
Fangjian Duan ◽  
Shi Pu ◽  
Hongmei Peng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Shared Decision Making ◽  
Shared Decision ◽  
End Stage Kidney Disease ◽  
Related Factors ◽  
End Stage

Abstract Purpose Shared decision-making (SDM) about the type of renal replacement therapy to use is a matter of great importance involving patients, their families, and health treatment teams. This review aims to synthesize the volume of qualitative work explaining the factors influencing SDM regarding renal replacement therapy. Methods A systematic review and qualitative meta-synthesis approach recommended by JBI was used, six databases were searched. Studies were qualitative or mixed research published since 2000, with a primary focus on patient experiences, perceptions and practices regarding which method to choose for renal replacement therapy in End-Stage Kidney Disease (ESKD) patients. All themes were analyzed and compared to the established connectedness. Results A total of 1313 patients were enrolled in 32 studies focusing on factors associated with SDM regarding renal replacement therapy were included. All quality evaluations of the literature were medium to high. Four common themes were identified in our synthesis: (1) patient personal reasons, (2) family-related factors, (3) health care professional-related factors, and (4) social factors influence. Conclusion The model proposes pathways that could be explored further in future qualitative and quantitative studies and suggests that patients’ beliefs, emotions, and awareness should be targeted alongside patients’ decision-making practices to increase the efficacy of interventions. The majority of studies included in this review focus on older patients, and all report patients’ perspectives. Further research is required to understand the family member perspectives on SMD of renal replacement therapy.

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